Checklist of Nonverbal Pain Indicators (CNPI)

SubjectsPanel rating: 1Subjects-Panel CommentaryAlthough content validity was not evaluated through an external review bycontent experts, the CNPI does appear to have face validity for assessment ofpain in elders with dementia.The tool was tested in a convenience sample of 88 cognitively impaired andcognitively intact subjects undergoing surgery for hip fracture.Average age: 83.2 (±7.7) Range: 65-101.Gender: Female: 86%, Male: 14%.MMSE was used to assess for cognitive status with a cutoff for cognitiveimpairment at ≤ 23.Average MMSE for total sample =18.1Fifty-three patients had MMSE ≤ 23. Average MMSE: 12.2 (±8.0).Thirty-five patients had MMSE > 23. Average MMSE: 27.2 (±1.9).Acute care hospital setting is clearly identified as the care setting.No testing in long term care is currently available.The cognitively impaired patients have been identified as having dementiausing the MMSE, which is an appropriate instrument for screening fordementia. The cognitively impaired elders in this study have a low level ofcognitive function on the MMSE. However, acute confusion was notmeasured and is also often present in hospitalized elders with hip fracture.Age of the subjects is appropriate.The sample is predominantly women.There is no information on ethnic/racial diversity.Using 5 subjects per tool item as a rule of thumb, a minimum sample size of30 subjects (6 items x 5 subjects) would be needed. Thus, this sample of 88subjects is sufficient for tool evaluation.Administration, Scoring, FeasibilityPanel rating: 2Administration,Scoring,Feasibility-Panel CommentaryThere are 6 items, each of which is further defined by specific behaviors.Each item is scored on a dichotomous two point scale (0= not present ;1=present). The points are then added together.Pain is measured at rest and on movement with separate scores for eachsituation.Method of administration is clear.Scoring procedures are clearly described and simple to follow.No interpretation of tool score is provided.Clinical utility• Time: The time needed to administer the tool has not been formallyevaluated. However, the tool is short and appears easy to use.• Skill needed: Skill level needed to use the tool reliably is not addressed.In the initial study, two gerontological nurse practitioners didassessments. However, it is not known how the tool performs whenadministered by staff nurses.Completed 04/04 2